Kenpo Karate Woodland Park, CO - Kenpo Karate Colorado Springs - Kenpo Karate Colorado

Waiver/Release Form

Kenpo Karate of Woodland Park, Colorado
Welcome to our Studio
Introductory Application for Kenpo

Name _________________   Date ____________  Email _______________

_____Male  _______Female            Age ______    Date of Birth _______________

(Parent or Legal Guardian if under 18) Name _______________________________

Home Phone Number ___________ Emergency Contact Number _________________

Address ____________________________________________________

Is anyone else responsible for the decisions or the tuition for the lessons?  ____YES  ____ NO

If YES, Who : ________________________________

How did you find out about Kenpo Karate of Woodland Park, Colorado ______________

Learning Objectives  __Self Defense __Confidence __Strength Building __ Weight Control  __Sport ___Physical Conditioning ___Martial Arts Philosophy ___Meditation/Relaxation  ___Discipline ___Tournaments/Competitions ___Stress Relief ___Bully Management

Waiver and Release

I hereby agree to participate in Kenpo Karate of Woodland Park, Colorado (the school) martial arts & fitness programs given by its owners, employees and agents, upon the understanding that:

1.        I represent to PHOENIX fitness & Kenpo Studio of Colorado Springs that I have no physical, mental or emotional illness that could impair training or that could make the training injurious.  While every effort will be made on the part of the school to make the classes and facility as safe as possible, I realize that any physical activity has the potential for injury and I waive any claim of accidental and/or negligent tort against the school and its owner(s), employees and agents resulting from this activity.
2.       I also release the school from any liability arising from my use of any and all equipment provided by the school.
3.       I understand that I will also be held responsible for any negligent damage (replacement/repair) to equipment I am using that is owned or provided by the school.

__________________         ______________________  __________________
Student                                              Parent or Legal Guardian(if under 18)      Witness

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Thom with the DARE Bear in Woodland Park

Thom with the DARE Bear in Woodland Park
DARE = DRUG Abuse Resistance Education